Recovery from COVID-19 is not always uneventful, especially in critically ill hospitalized patients. Persistent symptoms including fatigue/ weakness, short of breath, anxiety and depression has been described at one year follow-up. Furthermore, symptoms from the musculoskeletal system like joint pain or stiffness are underreported in studies with long-term follow-up up to one year. Infection with SARS-CoV-2 itself has been associated with endothelial damage, and together with high dose corticosteroid treatment, predispose to the dissemination of micro-thrombi and the development of femoral head osteonecrosis (FHOn), as it has been shown during the previous (2003-4) coronavirus outbreaks. A resurgence of FHOn cases is anticipated but this is not reflected in the existing studies with long-term follow-up. Prompt diagnosis is critical for early treatment and possibly for the hip joint preservation. COVID-19 patients treated with corticosteroids should be screened for avascular necrosis early after discharge from the hospital. Every health care worker involved in the management of these patients should maintain a high level of suspicion and be alert when patients report symptoms such as vague ache at the buttocks, the hip area, the adductors and/or above the knee. Studies are needed to identify risk factors for FHOn including disease severity, type of steroid, cumulative dose, and duration of treatment.
Fuente: International Journal of Infectious Diseases
Available online 21 April 2022